Mobility Decline in Old Age

Merja Rantakokko; Minna Mänty; Taina Rantanen


Exerc Sport Sci Rev. 2013;41(1):19-25. 

In This Article

Person-environment Interaction in the Progression of Mobility Decline

People with mobility limitations report more barriers in their environment than people without limitations. Examples of barriers often reported by older people include poor public transportation, discontinuous or uneven sidewalks, curbs, noise, heavy traffic, inadequate lighting, lack of resting places, sloping terrain, long distances to services, and weather conditions. However, most studies have been limited to cross-sectional analyses and have been unable to reveal whether people report environmental barriers because of their mobility limitation or whether environmental barriers accelerate mobility decline. Our recent study among community-dwelling older people showed that those who reported barriers to walking in the outdoor environment had approximately twofold risk for incident difficulty in 2 km and 0.5 km walking (Fig. 2).[24] In addition, fear of moving outdoors markedly increased the risk for incident walking difficulties (Fig. 3). Fear of moving outdoors is an example of a negative effect resulting from a perceived mismatch between environmental press and individual competence[9] and may lead to avoidance of outdoor activities.[25] Fear-related avoidance of walking outdoors may, because of the consequences of physical inactivity, accelerate the progression of mobility decline.[23]

Figure 2.

The rates of incident walking difficulty (Yes) in groups based on perceived barriers in the outdoor environment among community-living people aged 75 to 81 yr without difficulties in walking at baseline. Follow-up time was 3.5 yr, with repeat interviews taking place every 6 months. Barriers in the outdoor environment studied were lack of resting places and long distances (Distances), hilly terrain and poor street conditions (Terrain), and noisy traffic and dangerous crossroads (Traffic). [Adapted from [23]. Copyright © 2011 own.]

Figure 3.

Unadjusted prevalence of perceived difficulty in walking 0.5 km (n = 266) and 2 km (n = 214) among 75- to 81-yr-old people without difficulty at baseline who were followed up every 6 months for 3.5 yr. The P indicates statistical significance over the follow-up. OR, odds ratio. [Adapted from [25]. Copyright © 2009 John Wiley and Sons. Used with permission.]